Provider Demographics
NPI:1821077553
Name:KIM, JAY J (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:J
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 W MARKET ST STE 2K
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4602
Mailing Address - Country:US
Mailing Address - Phone:419-996-4011
Mailing Address - Fax:419-996-4012
Practice Address - Street 1:730 W MARKET ST STE 2K
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-4602
Practice Address - Country:US
Practice Address - Phone:419-996-4011
Practice Address - Fax:419-996-4012
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18287208G00000X
OH35.098205208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2493789OtherOH MEDICAID MOLINA
OH000000433626OtherOHIO MEDICAID UNISON
OH310917085258OtherOH MEDICAID CARESOURCE
WV0129081000Medicaid
OH2493789Medicaid
OH2493789OtherOH MEDICAID MOLINA
WV0129081000Medicaid
OH2493789Medicaid